García-de León Gómez JM, Landero-Orozco MA

Language: Spanish
References: 4
Page: 178-181
PDF size: 392.57 Kb.

ABSTRACT

Background: Congenital anomalies such as spina bifida, imperforated anus, Hirschsprung’s disease, as well as repeat pelvic surgeries can cause fecal incontinence and constipation. Retrograde enemas via the anus are not always effective as severe constipation and fecal incontinence management.
Material and methods: We describe 10 patients (five boys and five girls) seen over a period of nine years with a medical history of partial bowel obstruction secondary to chronic constipation. The antegrade enema technique consists of localizing the cecal appendix without detaching it from the cecum, opening the tip, and moving it to the abdominal wall to form a stoma.
Results: Neurogenic bladder due to myelodysplasia was the underlying pathology. Simultaneous bladder enlargement was carried out in eight patients - in six of them with ileum, and in two of them with the sigmoid colon. A Monti stoma was made for bladder catheterization and a Malone stoma for the antegrade enemas. Malone stoma as the only surgery and without bladder enlargement was carried out in two patients. Mean hospital stay was eight days. The complication of stricture in the Malone stoma presented in one patient, requiring surgical reintervention for its resolution, and only one patient discontinued the enemas due to pain.
Discussion: When there is no response to conservative management, antegrade enemas are an excellent alternative for the treatment of patients with severe chronic constipation that frequently present with partial intestinal obstruction.

REFERENCES

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4. Casale AJ, Metcalfe PD, Kaefer MA, et al. Rink Total continence reconstruction: A comparison t stage reconstruction of neuropathic bowel and bladder. J Urol 2006;176(4 Pt 2):1712-1715.